10/12/2018 TB notifications, EU/EEA, 2016 58 994 TB cases notified in 30 EU/EEA countries Notification rate of 11.4 per 100 000 population (range 1.8–68.9) Cases per Screening for Latent TB among Migrants 100 000 population < 5 in the European Union 5 to 9 10 to 19 20 to 49 ≥ 50 Marieke J. van der Werf Not reporting International Conference on Migration Health (ICMH), Rome, Italy, 2 October 2018 Source: ECDC/WHO (2018). Tuberculosis surveillance 2 and monitoring in Europe 2018–2016 data Notified TB cases, EU/EEA, 2007–2016 TB in persons of foreign origin, EU/EEA, 2016 19 312 TB cases were notified in persons originating from Continuous decline between 2007 and 2016: Number of TB cases decreased by 31% other countries than the reporting country • Notification rate decreased by 32% 32.7% of all TB cases (range 0.2–96.0%) • 90 000 20.0 18.0 80 000 16.0 70 000 14.0 60 000 TB cases/100 000 12.0 TB cases 50 000 10.0 40 000 Proportion of cases 8.0 < 1% 30 000 6.0 1 to 9.9% 20 000 4.0 10 to 49.9% 10 000 2.0 50 to 74.9% 0.0 ≥ 75% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Not reporting Year of reporting Source: ECDC/WHO (2018). Tuberculosis surveillance Source: ECDC/WHO (2018). Tuberculosis surveillance 3 4 and monitoring in Europe 2018–2016 data and monitoring in Europe 2018–2016 data TB notification rates by origin and year, 2010-2015 Latent TB infection screening of migrants Country LTBI WHO-estimated TB Differences in type of migrants screening test incidence in country of origin screened for LTBI Belgium TST All • Children/adults Finland Only children • Asylum seekers/other Germany NA None migrants Greece TST All asylum seekers • Incidence in country of origin Italy NA None Netherlands TST or IGRA >50 Differences in LTBI tests Norway IGRA >200 Spain TST or IGRA High-incidence countries Sweden TST or IGRA >100 asylum seekers Switzerland NA None United Kingdom IGRA >150 Kunst et al. IJTLD 2017 5 Hollo et al. Eurosurveillance 2017 6 1
10/12/2018 Effectiveness of screening for latent TB infection among Performance of diagnostic tests for latent tuberculosis migrants to the EU/EEA – Analytic framework infection Study Results Pai et al. 2008 Sensitivity, specificity (95% CI) TST overall: sensitivity: 77% (71–82) TST in BCG-vaccinated: specificity: 59% (46–73) TST in non-BCG-vaccinated: specificity: 97% (95–99) IGRA (QFT): sensitivity: 76% (72–80), specificity: 98% (96–99) IGRA (QFT-3G): sensitivity: 70% (63–78) IGRA in BCG-vaccinated: specificity: 96% (94–98) IGRA in non-BCG-vaccinated: specificity: 99% (98–100) IGRA (T-SPOT.TB/ ELISpot): sensitivity: 90% (86–93), specificity: 93% (86–100) IGRA (T-SPOT.TB): specificity: 87% (80–92) Kahwati et al. Sensitivity, specificity (95% CI) 2016 TST (10 mm): sensitivity: 79% (71–87), specificity: 97% (96–99) (Not BCG IGRA (T-SPOT.TB): sensitivity: 90% (87–93), specificity: 95% (92–98) vaccinated) IGRA (QFT-3G): sensitivity: 80% (77–84), specificity: 97% (94–99) Kik et al. 2014 Pooled IRR PPV NPV TST: 2.07 (95% CI: 1.38–3.11) 1–7% 92–100% IGRA: 2.40 (95% CI: 1.26–4.60) 0–13% 88–100% Greenaway et al. Eurosurveillance 2018 7 Greenaway et al. Eurosurveillance 2018 8 Efficacy of therapy for latent tuberculosis infection Latent tuberculosis infection care cascade Zenner et al. Annals of Internal Medicine 2017 9 Alsdurf et al. Lancet Infectious Diseases 2016 10 Cost effectiveness Evidence-based statement (Draft) 16 cost-effectiveness analyses studies Offer LTBI screening using a TST or an IGRA soon after arrival for all migrant populations from high TB incidence countries and link to care Designs and outcomes heterogeneous and treatment where indicated. (Certainty of evidence: low) Cost-effectiveness of screening strategies dependent on • LTBI test characteristics which tests were being compared • • cost of tests BCG vaccination status of population • 11 12 Greenaway et al. Eurosurveillance 2018 2
10/12/2018 Acknowledgements Christina Greenaway Robin Christensen Manish Pareek Anh Tran Claire-Nour Abou Chakra Nick Rowbotham Moneeza Walji Marieke J van der Werf Iuliia Makarenko Teymur Noori Balqis Alabdulkarim Kevin Pottie Catherine Hogan Alberto Matteelli Ted McConnell Dominik Zenner Brittany Scarfo Rachael L. Morton 13 14 3
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